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HomeMy WebLinkAboutBLDG-19-000960 _ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK swi=g` -= lra g CITY Yarmouth —1 MA DATE 8/13/18 PERMIT#846-151-61"r d JOBSITE ADDRESS 41 Country Club Dr. OWNER'S NAME Madelyn Allaire GOWNER ADDRESS PO Box 222 South Yarmouth,MA 02664 .1 TEL 508 394-1075 JFAX PPE OR R OCCUPANCY TYPE COMMERCIAL EDUCATIONAL [ RESIDENTIAL 0T CLEARLY NEW:O RENOVATION:U REPLACEMENT:0 PLANS SUBMITTED: YES[] NOD APPLIANCES 1 FLOORS-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 111111111111ISSIIIIISMILIIIIIIIIISIIIIIIIIMINIIIIINI BOOSTER MIMI 11111111111111111111111111 M 1111.1111111111111111 CONVERSION BURNER M ®IIIMINII ® BI COOK STOVE IIIIIIIII -- a - -- ��� DIRECT VENT HEATER 1U1 - �����1111111111111111111111S FRYER III IINIIMIIIIIIIIIIII , all= 11111111111111111.1 IREPLACE IIIIIIIIINIIIIMININIIIIIIIIISMINIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII FRYOLATOR I= ®111111111151111I 1111111111111111111111111111111111111 FURNACE 111.11111111SIINIIIIIIIIIIIIIIIIIIIIIIIMINIMINIIIIIIINISIIIIIIIIIIIIIII GENERATOR n._____.11111111111111_111111111111111N1111111111111111111I— GRILLE 111M IIIIIIIIIIII ' M1111111111111 Milian' INFRARED HEATERINIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIMIIIIIIIIIIIIIIIIIII0111110111111 LABORATORY COCKS 111111111111111111111111111111111111111111111111111111111111111111111111111111111 MAKEUP AIR UNIT 1111211.11111•1111111111111 ®®111•111MMI®ga OVEN 11111111111111111111 IMIIIIIIIIIIINIIIIIIIIIIIIIIINIIIIIINIBIMMIIIIIIIIIII POOL HEATER IIIIINIIIIIIIII 11111111111111111111111111111111111111111111/1111111111111 ROOM ISPACE HEATER111111111111a11111111111111111111111111111111111111111111111111111111111111011111011111111111111 ROOF TOP UNIT N1111111111111111111111111111111INS TEST 111.1111111111111111111111111 1111111___S UNIT HEATER MISIIIIIMMI _III—_____ IIIIIIIIIIIII UNVENTED ROOM HEATER 111111.11111111111111111111NIIIIIIIII®®MIIIIIIM - �'IIIIIIMIII� WATER HEATER 111111111111111111' NM IIIIIIIIIIIIIIIMININI IIIII OTHER _____ ®IIIIIIIIIMMINIMINIIIIIIIMMI' ®SIS I INIIIIMEMI 111111 St= INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES [;j NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ED OTHER TYPE INDEMNITY [Y,) BOND Q OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER © AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and Information I have submitted or entered regarding this ap• catio are true and accur to he best of my knowledge and that all plumbing work and installations performed under the permit issued for this application ill be co Iia it Pe nent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAMEWilliam B.Holmes LICENSE#I45' - SI ATURE MP❑ MGF p+ JP Li JGF❑ LPGI Li CORPORATION G# 043585106 PARTNERSHIP pit; LLC D#I_ I COMPANY NAME: RCA Electrical Contractors Inc. ADDRESS 381 Old Falmouth Road,Unit 13 I CITY Marstons Mills STATE MA ZIP 02648 JTEL 508-428-0449 FAX IIIMIIIIIIIII CELL REMAIL{ellen agrcaelectric.com I 'a ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ 9 r• Al/a 6/9 6"-5 cif FEE: $ PERMIT# J(6),( R PLAN REVIEW NOTES i�/�ft